Khat chewing habit produces a significant adverse effect on periodontal, oral health: A systematic review and meta-analysis

Predictors and perinatal outcomes of pre-labor rupture of membrane among pregnant women admitted to Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia: a retrospective study

Background

Pre-labor rupture of membrane (PROM) refers to a membrane rupture that occurs after the 28th week of pregnancy but before the start of labor. If not appropriately managed, it poses a significant risk to the health of the mother and fetus. However, information on the magnitude of PROM, contributing factors, and its perinatal outcomes was limited in Eastern Ethiopia. This study assessed the prevalence, predictors, and perinatal outcomes of PROM among pregnant women admitted to Hiwot Fana Comprehensive Specialized University Hospital (HFCSUH) in Eastern Ethiopia so as to guide specific preventive measures.

Methods

A hospital-based retrospective cross-sectional study was carried out from May 15 to June 14, 2022, and data were gathered by reviewing the chart records of 424 pregnant women who were admitted to maternity and labor wards in the previous two years, from January 1, 2019 to December 31, 2020. Records were chosen using a simple random sampling method. Mother's socio-demographic traits, previous obstetric and gynecologic history, current pregnancy history, habit-related history (khat chewing), ultrasound findings, laboratory investigations, mode of delivery, maternal and perinatal outcomes were extracted from the maternal charts. Bi-variable and multivariable logistic regression analyses were performed to identify predictors of pre-labor membrane rupture. The association between the explanatory and outcome variables was expressed using an adjusted odds ratio with a 95% confidence interval.

Results

The prevalence of pre-labor membrane rupture was 16.27% with 95% CI: (13.05-20.11). Among 69 women who experienced pre-labor rupture of membrane, 50 (72.5%) of them had adverse perinatal outcomes. Of all 69 neonates 17 (24.64%) were delivered with low birth weight and 20 (29%) of them were born preterm. The overall perinatal mortality rate was 10.1% or 101 per 1,000 live births. History of abortion [AOR = 2.61; 95% CI (1.09, 6.24)], urinary tract infection [AOR = 2.59; 95% CI (1.23, 5.42)], antepartum hemorrhage [AOR = 3.35; 95% CI (1.38, 8.13)], and khat chewing (a leafy plant which contains psychoactive chemical) in the current pregnancy [AOR = 2.63; 95% CI (1.49, 4.63)] were all significantly associated with pre-labor rupture of membrane.

Conclusion

In this study, the magnitude of pre-labor membrane rupture was relatively high compared to the global rate. Prenatal risk identification and early detection of complications among mothers with a history of abortion, antepartum hemorrhage, urinary tract infection, and counseling on the effects of khat chewing during pregnancy are crucial to reduce the likelihood of pre-labor membrane rupture and its adverse perinatal outcome.

Exploring the perception of key stakeholders toward khat policy approaches in Ethiopia: a qualitative study

BACKGROUND

Khat is an amphetamine-like plant, produced and commonly chewed in Ethiopia by a large group of the population. Although significant multidimensional harms of khat use have been reported, currently, there are no policies or organized activities against khat use in Ethiopia. Therefore, the current study aimed to explore the perception of key stakeholders toward khat policy approaches for Ethiopia.

METHODS

A qualitative study was conducted using focus group discussion (FGD) and in-depth interview (IDI). Ten stakeholders participated in the IDIs, and another 15 individuals participated in the FGDs. Key stakeholders were appropriately mapped and purposively selected based on their experience related to khat use and khat harm reduction. Interviews and FGDs were led by the study authors and were audio-recorded. The audio-recorded data were transcribed verbatim and then translated into English language. The data were analyzed using thematic analysis approach.

RESULTS

Participants preferred prevention and law regulation measures for khat policy approaches for Ethiopia. Proposed prevention and law regulation measures included regulating the transportation of khat, limiting the minimum age to buy and sell khat, prohibiting khat use at some public places, banning khat advertising and promotion, and imposing excise tax. Individual level khat harm reduction strategies were also proposed to be useful. However, the participants asserted that total khat ban in Ethiopia is not likely to be feasible and acceptable.

CONCLUSION

Prevention, treatment or care for individuals with problematic khat use, law regulation, and harm reduction were preferred approaches by stakeholders for khat policy in Ethiopia instead of total banning.

Cone-beam computed tomographic analysis of maxillary sinus septa among Yemeni population: a cross-sectional study

BACKGROUND

Maxillary sinus septa increase perforation risk of Schneiderian membrane during the sinus floor elevation (SFE). Cone Beam Computed Tomography (CBCT) allows for a more precise assessment of the septal position; thus, preoperative CBCT analysis is substantial to avoid possible complications. This study aims to investigate the 3D characteristics of the maxillary sinus septa based on CBCT images. To our knowledge, no study reported the CBCT-based investigation for the sinus septa among Yemeni population.

MATERIALS AND METHODS

This is a retrospective cross-sectional analysis of 880 sinus CBCT images 440 patients. The septa prevalence, locations, orientations, morphology, and associated factors were analyzed. The effect of age, gender, and dental status on the sinus septa and the relationship between sinus membrane pathology and sinus septa were also analyzed. Anatomage (Invivo version 6) was used for CBCT images analysis. Descriptive and analytical statistics were performed, and a P-value < 0.05 was significantly considered.

RESULTS

The maxillary sinus septa were found among 63.9% of patients and 47% of sinuses. The average septa height was 5.2 mm. 15.7% of patients had septa in the right maxilla, 18% in the left, and 30.2% in both. Gender, age, and dental condition had no influence on the presence of septa, and septa presence did not influence sinus membrane pathology. Many septa originated from the floor (54.5%), located in the middle (43%), with coronal orientation (66%) and complete configuration (58.2%).

CONCLUSION

Based on our findings, the septa prevalence, locations, orientations, and morphology were significant and equivalent to the highest recorded in the literature yet. Thus, when sinus floor elevation is planned, CBCT imaging of the maxillary sinus is recommended for safe dental implantation.

Khat (Catha Edulis Forsk) induced apoptosis and cytotoxicity in cultured cells: A scoping review

Background

Khat (Catha edulis Forsk) leaves are chewed by people in certain regions of East Africa and the Middle East for their stimulating amphetamine-like effects. The purpose of this scoping review is to systematically map the current in vitro publications that investigated the toxicological potential effects of khat on cultured human or animal cells in terms of cellular viability and activity.

Methods

A comprehensive electronic database search was undertaken up to December 2020 without starting date or language restrictions in accordance with the PRISMA extension for scoping review guideline and methodological quality evaluation based on the guidelines for reporting pre-clinical in vitro studies on dental materials. All in vitro studies that investigated the effect of khat plant extract (Catha Edulis) on the cultured human or animal cells were included.

Results

The initial search yielded 599 articles and 16 articles were finally selected to be included. The treatment of cells with khat produced different degrees of cellular changes, including decreased cellular survival, induction of apoptosis, increased ROS production, alteration of cell phenotype, and of arrest cell cycle. In this contest, khat-exposed cells expressed higher levels of pro-apoptotic protein Bax and lower levels of anti-apoptotic Bcl-2, up-regulated p38, p53, p16, and p21 proteins, as well as premature expression of differentiation markers.

Conclusion

Based on the current scoping review, khat induced apoptosis and cytotoxicity in cultured human cells, including oral cells.

Link between perceived oral and general health status among Yemeni adult dental patients

BACKGROUND

Self-perceived health is an essential measure of health status and even a paramount predictor of mortality. So long as it is said that oral health (OH) and general health (GH) are mirrors to each other. This study sought to determine how Yemeni adults rate their OH and GH, whether such a self-rating influenced by some potential risk factors, and whether both ratings (OH and GH) are correlated.

METHODS

A sample of 587 Yemeni dental patients aged 20 years and over were consecutively recruited. A structured interview form was used covering the following variables: age, gender, marital status, educational level, presence of dental prosthesis (DP), smoking and Qat chewing habits as independent variables, along with questions on "perceived oral health (POH)" and "perceived general health (PGH)" as dependent variables. The bivariate and multiple ordinal regression analyses were applied at P-value < 0.05.

RESULTS

Most of participants were women (73.6%), and married (71.4%), and more than half of them were young adults (58.2%), with high educational levels (53.3%), and not having DP. Only 310 participants responded to the questions on smoking and Qat chewing habits. Of these, 88.5% were non-smokers and 62.1% were Qat non-chewers. Up to 50% of the participants reported their POH as poor or fair, while lower proportions of participants (17%) reported their PGH as such. Younger age (compared to elders), high education levels (compared to primary education) and being single (compared to married) significantly revealed better levels of POH, while high education levels and being females significantly revealed better levels of PGH. Smoking and Qat chewing habits were found to have no effect on the perception of POH or PGH. POH and PGH were found to be significantly correlated (r = 0.486; P < 0.001).

CONCLUSION

Higher levels of oral health problems can be anticipated among patients who perceive poor general health, and vice versa. The age, marital status and education were independent determinants of POH, while the gender and education were independent determinants of PGH.

Impact of khat price increases on consumption behavior - price elasticity analysis

Background

The long border of Saudi Arabia with Yemen is the primary route for khat entry to the Kingdom. As of April 2015, the government of SA tightened the border, making it more difficult to import khat into the country. As a result, local user prices of khat probably increased due in part to higher supply costs and perhaps lower quantities. One anti-drug strategy is to increase consumption cost by increasing the price of supply. We aim in this study to measure the responsiveness of khat demand to price changes.

Methods

This study used a cross-sectional survey design. Two stage sampling was used to recruit 350 khat chewers from four selected primary healthcare centers in Jazan province (South western province of Saudi Arabia). The data were collected during the first quarter of 2017. This study used both contingent valuation and revealed preference methods to assess the impact of price increases on the purchasing of khat. Graphical analysis, paired-samples t-test, and one-way repeated measures analysis of variance (ANOVA) were used to assess the impact of price increases on khat consumption.

Results

The study results showed a significant decrease in khat consumption amount (t = 8.63, p ≤ 0.05), frequency (t = 30.42, p ≤ 0.05), and expenditure (t = 34.67, p ≤ 0.05) after the tightening of the Saudi–Yemeni border. Hence khat demand is price elastic. The price elasticity of khat demand in Jazan is estimated to be between − 2.38 and − 1.07. Therefore, each 1% increase in price is associated with 1–2% reduction in quantity demanded. This means khat chewers are relatively responsive to price changes (i.e., khat demand is price elastic). Repeated measures analysis of variance showed price increases significantly affect the quantity {F(4, 2.58) = 257, p ≤ 0.05, ηp² = 0.423} and frequency {F(4, 1.83) = 415, p ≤ 0.05, ηp² = 0.543} of khat chewing.

Conclusions

Increased prices for khat would significantly decrease demand. Accordingly, we recommend implementing law enforcement strategies focused on disrupting the khat supply chain to realize high prices and so discourage use, hence reducing the incidence of khat-related illnesses.

User Experiences of Prescription and Over-The-Counter Drug Abuse in Aden City, Yemen

Khat chewing is commonplace in Yemen, but little else is known about the misuse of other drugs, especially how such misuse may intersect with Khat use. The aim of this study was to investigate misuse of prescription and over-the-counter (OTC) drugs in community pharmacies in Aden city, from the users’ perspective. A qualitative in-depth-interview study was undertaken with fifteen known or suspected drug misusers, recruited through community pharmacies. Thematic analysis was used to identify the main emergent themes around experience of prescription and OTC drug misuse. The majority of interviewees were male (n = 11/15) with an age range of 21–40 years. Benzodiazepines, Tramadol, and Ketoprofen were the most commonly misused drugs. Four main themes were identified: Experience sought with drugs; awareness of problematic drug use; pattern and methods of misuse; and the role of healthcare professionals in responding to misuse. The study highlighted different issues, such as the practice of mixing different OTC and prescription drugs with Khat to heighten the effects or manage associated pain, and drug misuse by females and by health care professionals. The study also suggested that physicians and pharmacists fear counselling such people, probably with the risk of violence as a contributory factor.

Antioxidant capacity and biomarkers of oxidative stress in saliva of khat-chewing patients: a case-control study

OBJECTIVES

The aim of this study was to investigate the antioxidant levels and biomarkers of oxidative stress in saliva from khat-chewing patients compared with controls.

STUDY DESIGN

Saliva samples were collected from 51 chronic khat chewers and 46 age- and sex-matched controls. Concentrations of oxidative stress biomarkers (malonyl-dialdehyde [MDA], protein carbonyl, and 8-hydroxy-2'-deoxyguanosine) and antioxidant defense (total antioxidant capacity [TAC], superoxide dismutase, glutathione peroxidase, and catalase [CAT) were analyzed.

RESULTS

Salivary MDA level in the khat users group (45 ± 9.2 nmol/mL) was significantly increased in comparison with controls (13 ± 2.1 nmol/mL; P < .001), but there were no significant differences between the 2 groups regarding the levels of salivary protein carbonyl and oxidized guanine species. Salivary TAC was significantly reduced in khat users (0.25 ± 0.028 mmol/L) in comparison with controls (0.34 ± 0.037 mmol/L). Salivary CAT level was significantly reduced in khat users (6.0 ± 0.47 U/mL) in comparison with controls (7.7 ± 0.43 units/mL; P <.05), but no significant differences were observed between the 2 groups with regard to salivary superoxide dismutase or glutathione peroxidase levels.

CONCLUSIONS

Chronic khat chewing is associated with increased levels of salivary MDA and reduced levels of TAC and CAT among a population of adult men in comparison with non-khat-chewing controls. These findings suggest that the pro-oxidative effect of khat chewing may be a contributing mechanism for various oral diseases associated with khat use, including cancer, periodontitis, and caries.

Khat chewing increases the risk for developing chronic liver disease: A hospital-based case-control study

The chewing of the leaves of Catha edulis (khat) has been implicated in the development of liver disease, but no controlled observations have been undertaken. The objective of the present study was to determine whether khat chewing is associated with development of chronic liver disease (CLD). A case-control study was conducted at two public hospitals in Harar, Ethiopia, between April 2015 and April 2016. A consecutive sample of 150 adult hospital attendees with CLD were included as cases, and 300 adult hospital attendees without clinical or laboratory evidence of CLD were included as controls. Khat consumption was quantified in "khat years"; 1 khat year was defined as daily use of 200 g of fresh khat for 1 year. A logistic regression model was used to control for confounders. There was a significant association between chewing khat and the risk for developing CLD (crude odds ratio, 2.64; 95% confidence interval [CI], 1.56-4.58). In men, this risk, following adjustment for age, alcohol use, and chronic hepatitis B/C infection, increased with increasing khat exposure; thus, compared to never users the adjusted odds ratios were for low khat exposure 3.58 (95% CI 1.05-12.21), moderate khat exposure 5.90 (95% CI 1.79-19.44), and high khat exposure 13.03 (95% CI 3.61-47.02). The findings were robust in a post hoc sensitivity analysis in which individuals with identifiable risk factors for CLD were excluded.

CONCLUSION

A significant association was observed between chewing khat and the risk for developing CLD, and in men the association was strong and dose-dependent, suggesting a causal relationship; as the prevalence of khat chewing is increasing worldwide, these findings have major public health implications. (Hepatology 2018;68:248-257).